The medical records of all patients with a primary or secondary hospital discharge diagnosis of AMI (Ninth International Classification of Disease Codes 410 and 411) from participating hospitals were individually reviewed and validated according to predefined diagnostic criteria that have been described previously. In brief, these criteria included satisfaction of at least two of the following three factors: clinical history, serum enzyme level elevations, and serial electrocardiographic findings. The occurrence of selected complications during hospitalization for AMI was assessed on the basis of information available from the clinical charts. Congestive heart failure was regarded as present when there was evidence of pulmonary edema or bilateral basilar rales with an S3 gallop. Cardiogenic shock was considered present when the systolic blood pressure was less than 80 mm Hg in the absence of hypovolemia and associated with cyanosis, cold extremities, changes in mental status, and persistent oliguria. The definition of these complications remained the same over the periods under study and were defined so that patients with classic signs and symptoms of these complications would be included. In addition, all autopsy-proved cases of AMI were included irrespective of the other criteria. cialis professional
A total of 5,480 patients satisfied the diagnostic criteria for AMI during the seven study periods examined. Of these, 780 patients were hospitalized in 1975, 845 in 1978,999 in 1981, 714 in 1984, 765 in 1986, 659 in 1988, and 718 in 1990.
Differences in the distribution of selected characteristics between patients hospitalized for AMI who received as compared with those who did not receive PA catheterization were examined using the x2 test of statistical significance. All p values were two tailed. To examine the independence of the association of various patient demographic and clinical characteristics with PA catheter utilization, a logistic multiple regression analysis was carried out. The factors controlled for in this analysis included the following: patient age, sex, year of hospital admission, AMI order (initial vs recurrent), AMI location (anterior vs inferior/posterior), AMI type (Q wave vs non-Q wave), peak serum creatine kinase findings, and development of congestive heart failure or cardiogenic shock during the short-term hospital admission. A separate multivariate analysis of factors associated with PA catheterization was carried out among patients with complicated AMI. Complicated AMI was defined on the basis of the development of either congestive heart failure or cardiogenic shock at any time during the acute hospitalization.